Section 1618 of the Social Security Act (the Act) conditions the receipt
of Federal Medicaid funds by States providing supplementary payments under
section 1616(a) of the Act or section 212 of P.L. 93-66 on their "passing
through" to Supplemental Security Income (SSI) recipients the full amount
of federal cost-of-living increases. The appellants, eleven States,
contend that the pass-through provision is an unconstitutional exercise of
the Congressional spending power and a violation of the Tenth Amendment
because the condition imposed is totally unrelated to the Medicaid
program. The appellants also contest the Social Security Administration's
(SSA's) interpretation of the scope of section 1618 as applying not only
to those who are eligible for both SSI benefits and State supplementation,
but to those who, because of their income level, are eligible only for a
State supplement. In its review, the court of appeals found that the
legislative history of the Act and its amendments show that the
pass-through provision is closely tied to the goals of the Medicaid
program. It further found that the provision was enacted for the
permissible objective of guaranteeing that SSI cost-of-living increases
approved by Congress benefit those whom they were designed to assist --
SSI recipients, rather than the States. Accordingly, the court of appeals
held that the pass-through provision of section 1618 is a
conventional and appropriate exercise of Congress' authority under the
spending clause and is not coercive. The court further held that
the Secretary's interpretation of section 1618, in 20 CFR 416.2095(b)(3),
to include within its scope recipients who, because of their income,
receive only a State supplement accords with the statutory language and is
a reasonable exercise of the Secretary's authority to ensure fair and
effective administration of the pass-through provision.

MIKVA, Circuit Judge:

Appellants, eleven states,[1]
question the constitutionality of the "pass-through" provision of the
Supplemental Security Income (SSI) program of the Social Security Act
(Act), §§ 1-2007, 42 U.S.C. §§ 301-1397f (1976). The pass-through
provision, added to the Act in 1976, conditions the states' receipt of
federal Medicaid funds on their "passing through" to SSI recipients annual
cost-of-living increases approved by Congress. See Act § 1618, 42 U.S.C. §
1382g (1976). Although similar conditions have previously been imposed by
Congress, this device has never before been directly challenged by
affected states. Appellants charge that the pass-through provision
constitutes an abuse of the federal spending power and violates the Tenth
Amendment. They also contest the interpretation given the scope of section
1618 by the Secretary of Health, Education and
Welfare.[2]

Seeking declaratory and injunctive relief, the states brought this action
in the United States District Court for the District of Columbia. On
cross-motions for summary judgment, the court below granted judgment in
favor of the federal
government.[3] We affirm that
order.

I. THE LEGISLATIVE SCHEME

A. Statutory Background

The Social Security Act was enacted in 1935 as "a series of related
measures designed as a unified, well-rounded program of attack upon the
principal causes of insecurity in our economic life." S. Rep. No. 628,
74th Cong., 1st Sess. 2 (1935). It contained a number of titles pertaining
to five broad subject areas: old-age security, unemployment compensation,
aid to dependent children, public health measures, and aid to the blind.
Titles I and X established grant programs enabling the states to assist,
respectively, the aged and the blind. Title XIV, added to the Act in 1950,
provided grants to the states for the benefit of the permanently and
totally disabled.

Under these titles, the federal government reimbursed the states for part
of the cost of cash payments made to assist the needy in acquiring food,
shelter, and medical care. The states administered the programs and
determined the levels of assistance, but they had to comply with various
federal requirements in order to receive federal matching funds.

The Social Security Amendments of 1960, also referred to as the
Kerr-Mills Act, provided additional financial incentives to induce states
to improve medical care to the elderly. The new provisions were added to
Title I, the basic assistance program for the aged. The House report
indicated that state plans which attempted to finance the new health care
programs by diverting funds from existing public assistance programs were
to be disapproved. See H.R. Rep. No. 1799, 86th Cong., 2d Sess. 8
(1960).

In 1962, Title XVI was enacted, which permitted states to consolidate
their assistance programs for the aged, the blind, and the disabled. To
encourage the states to take advantage of this legislation, Congress
provided a more favorable ratio of federal matching funds for medical
assistance to the blind and the disabled under a combined plan than under
the former separate plans.

The Medicaid program, Title XIX of the Act, was established by the Social
Security Amendments of 1965 and is now the largest federal-state matching
fund program. See Oklahoma v. Harris, 480 F. Supp. 581, 583 (D.D.C.
1979). The states were authorized by these amendments to set up
comprehensive plans for supplying medical services to the needy. Health
care providers were reimbursed by the states for the cost of medical care
furnished to Medicaid recipients, and the states in turn recouped a
portion of their expenditures from the federal government. The Medicaid
program was designed to replace and consolidate the previously separate
health care components of the states' various cash assistance programs.
Congress directed that no state Medicaid plan was to be approved if it
resulted in a reduction of basic maintenance assistance to the needy.
See Act § 1902(c), 42 U.S.C. § 1396a(c) (1976).

Cash assistance programs for the aged, the blind, and the disabled were
federalized in 1972 with the establishment of the Supplemental Security
Income program. The SSI program is described in Title XVI of the Act,
which Congress revised to replace the ole Titles I, X, XIV, and XVI. The
federal government assumed responsibility for the administration and much
of the cost of the former assistance programs; it also determined
eligibility criteria for beneficiaries and set a uniform level of benefits
to be given to all recipients.

This uniform national payment exceeded the assistance received by aid
recipients under the superseded state-administered programs in some
states, and was less than that received by recipients in other states. In
order to ensure that no one suffered as a result of the new program,
Congress determined that states whose grant programs had set assistance
levels higher than the federal level should be required to make
supplementary payments. Accordingly, Congress conditioned a state's
eligibility for Medicaid funds on its willingness to make up any shortfall
between the federal SSI benefit and the amount a beneficiary received from
the state program as of December, 1973. See, Pub. L. No. 93-66, §
212, 87 Stat. 155 (1973), 42 U.S.C. § 1382 note
(1976).[4]

Moreover, Congress encouraged the states to provide optional
supplementary aid both to SSI recipients and to those who, though needy,
do not meet federal eligibility standards under Title XVI. See Act § 1616,
42 U.S.C. § 1382e (1976); H.R. Rep. No. 231, 92d Cong., 1st Sess. 199
(1971). Although this assistance comes entirely from state
funds,[5] the federal government
will, at the state's request, administer the payments at no cost to the
state. See Acts § 1616, 42 U.S.C. § 1382e (1976). Most states have chosen
to provide supplementary assistance, see 122 Cong. Rec. 34,543 (1976)
(remarks of Sen. Humphrey); id. at 28,280 (remarks of Rep.
O'Neill), and it was the reduction of such payments that led congress to
enact the pass-through provision.

B. The Pass-Through Provision

Title XVI guarantees SSI recipients automatic, annual cost-of-living
increases based on the Consumer Price Index. See Act § 1617, 42 U.S.C. §
1382f (1976). These increases began in 1974 but have been offset in many
states by a simultaneous reduction in the level of the state supplementary
payment -- sometimes by an amount equal to the cost-of-living increase, at
other times by a lesser
amount.[6] Thus, SSI recipients
in those states have been denied the full benefit of the cost-of-living
rises approved by Congress. Instead, the increased federal expenditures
have gone to provide fiscal relief to the states.

In order to prevent this result, Congress enacted the pass-through
provision in 1976. See Act § 1618, 42 U.S.C. § 1382g (1976). This
section conditions states' receipt of federal Medicaid funds on their
agreement to pass through to SSI recipients the full amount of the annual
federal cost-of-living increases. A state that supplements federal SSI
assistance must maintain those supplementary payments at a level no lower
than that in effect in December, 1976, or in the first subsequent month in
which supplementary payments are made. See id. § 1618(a), 42 U.S.C.
§ 1382g(a). A state is in compliance with this condition if its total
expenditure on supplementary payments in any twelve-month period is no
less than the amount spent in the preceding twelve months. See id.
§ 1618(b), 42 U.S.C. §
1382g(b).[7] The states are not
obligated to increase the level of supplementary benefits -- for example,
to keep pace with inflation -- but they must maintain the 1976 level of
those payments.[8]

Appellants contend that this provision is an unconstitutional exercise of
the congressional spending power and a violation of the Tenth Amendment
because the condition imposed is totally unrelated to the Medicaid
program. We turn now to discuss those allegations.

II. THE SPENDING POWER

A. The Applicable Principles

Appellants maintain that section 1618 exceeds congressional authority
under the spending clause, which gives Congress the "Power To lay and
collect Taxes . . . to . . . provide for the . . . general Welfare of the
United States." Art. I, § 8, cl. 1. appellants observe that none of
Congress' enumerated powers permit it to require the states to devote a
certain portion of their budgets to welfare programs. And they insist that
that result may not be accomplished indirectly via the terms imposed by
the pass-through condition, which is not related to the federal spending
program conditioned, that is, Medicaid. On the other hand, the court below
ruled, and appellees argue that Congress may condition the receipt of
federal benefits "[s]o long as the statute is reasonably related to the
general welfare and is enacted in furtherance of the Congressional power
to tax and to spend under the Constitution." 480 F. Supp. at 586.

We note initially that Congress' lack of authority to mandate directly
the result it hopes to encourage by means of the pass-through provision is
not an appropriate measure of congressional jurisdiction under the
spending clause. The Supreme Court has long recognized that the power to
spend for the general welfare is not limited by the direct grants to
congressional power enumerated in article I. Rather, the general welfare
clause is itself an independent -- and expansive -- source of Congress'
spending authority. See Fullilove v. Klutznick, 100 S.Ct. 2758,
2772 (1980) (opinion of Burger, C.J.); Buckley v. Valeo, 424 U.S.
1, 90-91 (1976) (per curiam); United States v. Butler, 297 U.S. 1,
66 (1936). Moreover, Congress' determination of what constitutes the
general welfare is entitled to a good deal of deference. In Butler,
the Supreme Court noted that one who contests congressional exercises of
the spending power must show that "by no reasonable possibility can the
challenged legislation fall within the wide range of discretion permitted
to the Congress." Id. at 67. Similarly, in Helvering v.
Davis, 301 U.S. 619, 640 (1937), the court held that a decision by
Congress in this area may not be overturned" unless the choice is clearly
wrong, a display of arbitrary power, [and] not an exercise of
judgment."

In addition to Congress' broad power to spend for the general welfare,
its ability to impose conditions on the receipt of federal funds is also
unquestioned. As the Supreme Court held in Oklahoma v. United States
Civil Service Comm'n, 330 U.S. 127, 144 (1947), "[t]he offer of
benefits to a state by the United States dependent upon cooperation by the
state with federal plans, assumedly for the general welfare, is not
unusual." See also Fullilove, 100 S.Ct. at 2772 (opinion of Burger,
C.J.); Massachusetts v. United States, 435 U.S. 444, 461 (1968)
(plurality); Lau v. Nichols, 414 U.S. 563, 569 (1974); King v.
Smith, 392 U.S. 309, 333 n. 34 (1968); Ivanhoe Irrigation District
v. McCracken, 357 U.S. 275, 295 (1958); Steward Machine Co. v.
Davis, 301 U.S. 548, 590-91 (1937).

The conditions that Congress may set in disbursing federal funds are not
restricted to those areas over which Congress has direct regulatory
authority. See, e.g., Oklahoma v. United States Civil Service
Comm'n, 330 U.S. at 143. Although there may be some limit to the terms
Congress may impose, we have been unable to uncover any instances in which
a court has invalidated a funding
condition.[9] Several times the
Supreme Court has spefically [sic] declined to articulate the precise
boundaries of Congress' discretion, see Fullilove, 100 S.Ct. at
2773 (opinion of Burger, C.J.); Lau, 414 U.S. at 569;
Butler, 297 U.S. at 67, and we see no need for this court to do so
here. As discussed in part II(B) infra, we are satisfied that the
pass-through provision represents an appropriate exercise of Congress'
spending power, and we find that appellants have erred in characterizing
the terms imposed by section 1618 as completely unrelated to Medicaid, the
program conditioned.

Before considering those points, we reject the rigid nexus test proposed
by appellants for determining the propriety of restrictions Congress sets
on the use of federal funds. Appellants maintain that a condition must be
precisely related to the purpose of the federal funds whose receipt is
conditioned: they urge the court to approve only those conditions aimed at
serving the same federal interest served by the funding program
conditioned here, Medicaid. That standard is not supported by the case
law.

In Oklahoma v. United States Civil Service Comm'n, for example,
federal highway funds were withheld from the state in an amount equal to
two years' compensation of a state highway official who had violated the
Hatch Act's prohibition of participation in political campaigns, § 12(b),
18 U.S.C. § 611(b) (1946) (current version at 5 U.S.C. § 1506(a) (1976)).
Similarly, in Lau, the Court approved a spending condition based on
section 601 of the Civil Rights Act of 1964, 42 U.S.C. § 2000d (1976),
which broadly proscribes discrimination on the ground of race or national
origin in "any program or activity receiving Federal financial
assistance." And in Fullilove, the Court upheld a provision of the
Public Works Employment Act of 1977, § 103(f)(2), 42 U.S.C. § 6705(f)(2)
(Supp. III 1979), conditioning receipt of public works grants on an
agreement by the state or local government grantee that at least ten
percent of federal funds will be allocated to contracts with minority
businesses. See also District of Columbia v. Train, 521 F.2d 971,
993 n. 26 (D.C. Cir. 1975) (citing section 2 of the Emergency Highway
Energy Conservation Act, Pub. L. No. 93-239, 87 Stat. 1046 (1974), 23
U.S.C. § 101 note (1976) (repealed 1975), which conditioned receipt of
federal highway funds on state's enforcement of fifty-five-mile-per-hour
speed limit), vacated and remanded on other grounds sub nom. EPA v.
Brown, 431 U.S. 99 (1977) (per curiam); Texas Landowners Rights
Ass'n v. Haris, 453 F. Supp. 1025 (D.D.C. 1978) (upholding provision
that denies both direct federal financial assistance for acquisition or
construction purposes and mortgage money from federally supervised private
institutions if community fails to participate in national flood insurance
plan), aff'd mem., 598 F.2d 311 (D.C. Cir.). cert. denied,
444 U.S. 927 (1979); City of Macon v. Marshall, 439 F. Supp. 1209
(M.D. Ga. 1977) (approving denial of federal mass transit grant to city
that refused to continue collective bargaining rights of bus company
employees).

In each of these cases, the condition imposed by Congress, and the
behavior of the grant recipient that the condition was designed to affect,
were not exactly correlated to the purpose for which the conditioned
federal funds were dispensed: the conditions and the general funding
programs were aimed at serving different federal interests. Nevertheless,
the courts recognized that in each instance Congress had legitimately
exercised its power to insist that those receiving federal benefits agree,
in exchange, to abide by the condition set by Congress. In none of the
cases did the courts require that Congress identify the relationship
between the terms imposed and the purposes of the funding programs
conditioned. Congress' constitutional power to fix conditions on the use
of federal funds may not be held to the modest limits proposed by
appellants.[10]

B. The Controversy Here

The condition imposed by the pass-through provision is clearly in line
with the statutes upheld in the Supreme court precedents cited above. The
Court has long recognized that alleviating the economic insecurity of the
needy is a legitimate congressional concern and one that may appropriately
be pursued by use of the spending power. See, e.g., Helvering v.
Davis, 301 U.S. 619, 644 (1937); Steward Machine Co. v. Davis,
301 U.S. 548, 593 (1937). Congress' purpose in enacting the pass-through
provision was to ensure that cost-of-living increases approved by Congress
would inure to the benefit of those whom the funds were designed to assist
-- SSI recipients, rather than the states. See, e.g., 122 Cong.
Rec. 34,543, 33,271, 28,278-84, 27,280-81 (1976). As Senator humphrey
noted:

[T]he Congress did not intend for SSI recipients to lose ground by
passing the cost-of-living increase. And our intent was not to provide
budget support to State government. We have revenue sharing. We have other
categorical programs which funnel funds into the States. this is not a
State Assistance program. It is a program to aid the elderly, the blind,
and the disabled.

Id. at 34,543.

Guaranteeing the proper use of federal funds is certainly an appropriate
congressional concern, and one of the typical justifications for attaching
conditions to grant programs. See, e.g., North Carolina ex rel. Morrow
v. Califano, 445 F. Supp. 532, 534-35 (E.D.N.C. 1977) (three-judge
court) (federal health care grants conditioned on state's establishing a
health planning agency that would approve development only of needed new
health services; condition designed to ensure efficient use of federal
funds), aff'd mem., 435 U.S. 962 (1978); Dupler v. City of
Portland, 421 F. Supp. 1314 (D. Me. 1976) (federal food stamp funds
conditioned on state's not reducing welfare payments and similar aid).
Here, Congress' objective could not be realized by amending Title XVI of
the Act, the portion relating to SSI, because it is individual needy
persons, not the states, that are entitled to the funds allocated to the
SSI program. In order to induce the states to pass cost-of-living
increases on to aid recipients, Congress deemed it necessary to attach the
pass-through condition to the Medicaid provisions of the act, under which
funds are disbursed to the states. We do not find that this choice --
involving the structure of the Social Security Act and the various methods
used to disburse funds -- renders the condition impermissible.

Appellants allege, however, that the condition is unconstitutional
because there is no relationship between a state's supplementary payments,
which are meant to be optional and to augment the uniform SSI benefit
level set by Congress, and the Medicaid program, which provides basic
medical assistance to the needy. We find this an overly simplistic and
compartmentalized characterization of the Social Security Act. Even were
we to accept appellants' suggestion that no link connects state
supplementary benefits and
Medicaid,[11] we could not
invalidate the pass-through condition. Appellant's description of section
1618 ignores the basic legislative purpose, which was not regulation of
state supplementation programs. Congress did not mandate that states
increase the level of supplementary benefits or devote a greater portion
of their budgets to assistance programs. It only directed that SSI money
appropriated by Congress for the benefit of the needy be spent on their
behalf. The pass-through provision is therefore in essence a condition
relating to the SSI program, not to state supplementary programs. Viewed
in this way, section 1618 is permissible even under appellants' rigid
nexus test: the assurance of SSI benefits -- the purpose of the
pass-through requirement -- is closely tied to the goals of the Medicaid
program. Indeed, SSI and Medicaid are two interrelated components of the
comprehensive federal effort to aid the aged, the blind, and the disabled.
Both programs are aimed at the same target population -- in fact,
eligibility for SSI payments automatically entitles one to Medicaid
benefits in most states[12] --
but each focuses on satisfying a particular need. Under the SSI program,
recipients are provided cash benefits to be used for basic subsistence,
whereas Medicaid is designed to furnish needed medical services.

The relationship between the two programs is not surprising. As Congress
has long acknowledged, the cost of medical care is one of the factors
determining need, and there is a causal relationship between economic
insecurity and ill health. See, e.g., H.R. Rep. No. 1300, 81st
Cong., 1st Sess. 41 (1949); S. Rep. No. 628, 74th Cong., 1st Sess. 21
(1935); H.R. Rep. No. 615, 74th Cong., 1st Sess. 13 (1935). When, in 1935,
Congress wished to make a "unified . . . attack" on the various causes of
economic dependence, it naturally provided funds for both medical services
and basic subsistence needs. S. Rep. No. 628, 74th Cong., 1st Sess. 2
(1935). The Social Security Act thus comprised a number of measures, each
"closely related to the others," that "together . . . constitute[d] a
broad, practicable plan to safeguard the security of the American family."
Id.

As originally enacted, the Act was structured according to type of
recipient: Title I pertained to the aged, Title X to the blind, and Title
XIV to the disabled. Each title included provisions relating to both
health and welfare benefits. When the Social Security Amendments of 1960
created additional financial incentives to tempt the states to improve
medical care to the elderly, the new health care provisions were added to
Title I, the basis assistance program for the aged.

This categorical approach to aid programs proved cumbersome, and the
organization of the statute gradually shifted so that classifications were
made according to type of benefit. In 1962, the former Title XVI was
enacted, which encouraged the states to combine their assistance programs
for the aged, the blind, and the disabled. The medical assistance
components of these programs were then consolidated in 1965 with passage
of Title XIX, the Medicaid provisions. The Medicaid portion of the statute
still covers medical services, while SSI was established in 1972 to
provide basic assistance benefits. The route to the present statutory
structure has been convoluted. But the process demonstrates that Medicaid
and SSI are not independent programs; rather, their current form has
evolved from an original statutory structure which clearly indicates that
Congress views medical benefits and basic subsistence payments as
components of one overall scheme.

Our interpretation is corroborated by other exercises of the
congressional power to condition the use of social security funds; the
pass-through provision is by no means unique in limiting a state's ability
to reduce its welfare expenditures in return for federal medical care
funds. For example, the Act directs the Secretary to disapprove state
Medicaid plans that result in a decrease of basic subsistence payments.
See Act § 1902(c), 42 U.S.C. § 1396a(c) (1976). This provision was
enacted in recognition of "the need and urgency for states to maintain, if
not improve, the level of basic maintenance provided for needy people
under the public assistance programs," and its purpose was to "prevent any
unwarranted diversion of funds from basic maintenance to medical care." S.
Rep. No. 404, pt. 1, 89th Cong., 1st Sess. 82-83 (1965); H.R. Rep. No.
213, 89th Cong., 1st Sess. 72 (1965). Similarly, the Kerr-Mills Act
required that state plans for medical care for the aged be rejected if
they were to be financed by diverting funds from existing state assistance
programs. Moreover, when the SSI program was initiated, and a uniform
federal benefit level set, Congress conditioned receipt of Medicaid funds
on state guarantees that recipients under the former state programs would
suffer no decrease in benefits. A state that had been making assistance
payments greater than the uniform SSI benefit level was thus required to
make up the difference to all those on its welfare rolls as of December,
1973. See Pub. L. No. 93-66, § 212, 87 Stat. 155 1973), 42 U.S.C. § 1382
note (1976).[13]

The legislative history of the Social Security Act and of its amendments
therefore refutes appellants' suggestion that the requirement that states
pass through SSI cost-of-living increases is unrelated to the purposes of
the Medicaid program. On the contrary, the relevant committee reports, the
evolution of the Act's structure, and other conditions set by Congress all
indicate that Medicaid funds and SSI benefits are two elements of one
scheme with a single aim. We find nothing impermissible in Congress'
conditioning a state's receipt of Medicaid funds on its compliance with
section 1618's mandate regarding the use of SSI
funds.[14]

We note that this result is consistent with our reluctance to become
excessively involved in the legislative process. In general, the courts do
not dictate to Congress the appropriate method for drafting statutes. It
is up to Congress to decide whether the Social Security Act should be
structured according to type of recipient, or according to type of
benefit, and whether all funds should be disbursed in the same way, or
some given directly to the recipients and others to the
states.[15] Likewise, Congress
need not make specific findings about the relationship between a condition
to be imposed on the disbursement of federal funds and the grant program
conditioned.[16] And the
wisdom of the terms set by Congress is not an appropriate concern of ours.
See Rosado v. Wyman, 397 U.S. 397, 422 (1970). At some point,
Congress' power to enforce restrictions on the use of federal money may be
limited. But we see no need to explore the boundaries of Congress'
discretion in a case in which the condition imposed clearly serves a
legitimate federal interest and is designed to effect the purposes of the
statute to which it is attached.

III. THE TENTH AMENDMENT

Closely related to appellants spending power argument is their challenge
to the pass-through provision as violative of the Tenth
Amendment.[17] Appellants
claim that section 1618 unconstitutionally diminishes the states'
sovereign power by dictating budget choices. The Tenth Amendment claim is
based, once again, on the absence of a relationship between the condition
and the funds conditioned and, additionally, on the Supreme Court's
opinion in National League of Cities v. Usery, 426 U.S. 833 (1976).
The first ground is as unpersuasive in this context as it was when
advanced with respect to the congressional spending power. As discussed
above in part II, we find appellants' nexus text overly rigid and
inconsistent with the case law, and we discern a reasonable connection
between the purpose of section 1618 -- to ensure that SSI cost-of-living
increases benefit assistance recipients -- and the goals of the Medicaid
program.

Second, National League of Cities by no means compels invalidation
of the pass-through provision. In that case, the court overturned 1974
amendments to the Fair Labor Standards Act which extended the statute's
wage and hour requirements to most state government employees. See 29
U.S.C. § 203(d), (s)(6), (x) (1976 & Supp. III 1979). The Court found
that insistence that state governments adhere to those provisions exceeded
Congress' power under the commerce clause, art. I, § 8, cl. 3, and
violated the Tenth Amendment. As every court reviewing challenges similar
to that before us has held, the Supreme Court's opinion is distinguishable
on two grounds.

First, the wage and hour provisions invalidated in National League of
Cities were held to be in excess of Congress' power under the
commerce clause. The Supreme Court specifically declined to rule
whether Congress could permissibly use its authority under the
spending clause to "seek to affect integral operations of state
governments." 426 U.S. at 852 n. 17. Although Congress may not direct the
budgetary decisions of the states, it may set conditions on the grant of
federal funds. As the Supreme Court held in Oklahoma v. United States
Civil Service Comm'n, 330 U.S. 127, 143 (1947), "[w]hile the United
States is not concerned with, and has no power to regulate, local
political activities as such of state officials, it does have power to fix
the terms upon which its money allotments to states shall be disbursed."
National League of Cities did nothing to repudiate that decision or
the long line of cases, discussed in part II(A) supra, that permit
Congress to impose conditions on the use of federal grants. This court has
thus refused to extend National League of Cities to Tenth Amendment
challenges to congressional action based on the spending power. See
County of Los Angeles v. Marshall, 631 F.2d 767, 769 (D.C. Cir.),
cert. denied, 101 S.Ct. 113 (1980). Other courts have ruled
similarly.[18]

Second the Fair Labor Standards Act amendments at issue in National
League of Cities mandated that state employees receive certain wages
and work a certain number of hours. The states were left with minimal
discretion in implementing those provisions and were subject to civil and
criminal penalties for violations. The Supreme Court thus found that the
Act "directly displace[d] the States freedom to structure integral
operations in areas of traditional governmental functions" and "appear[ed]
likely to have the effect of coercing the States to structure work
periods . . . in a manner substantially different from the practices which
[had] long been commonly accepted among local governments of this Nation."
426 U.S. at 852, 850 (emphasis supplied). Conditioning the receipt of
federal grants does not similarly impose a direct restriction on states'
decisionmaking: they may choose to conform to federal requirements or to
forego federal funds. This circuit has therefore held that National
League of Cities does not invalidate congressional attempts to induce
state cooperation with federal plans. See County of Los Angeles v.
Marshall, 631 F.2d at 769; County of Los Angeles v. Adams, 574
F.2d 607, 609 (D.C. Cir. 1978) (per curiam); Texas Landowners Rights
Ass'n v. Harris, 453 F. Supp. 1025, 1029-30 (D.D.C. 1978), aff'd
mem., 598 F.2d 311 (D.C. Cir.), cert. denied, 444 U.S. 927
(1979). See also District of Columbia v. Train, 521 F.2d 971,
992-93 (D.C. Cir. 1975) (distinguishing congressional efforts to compel
and to encourage before National League of Cities), vacated and
remanded on other grounds sub nom. EPA v. Brown, 431 U.S. 99 (1977)
(per curiam). Again, the decisions of other courts are in
agreement.[19]

in this case, unlike National League of Cities, states are
required to make no changes in policy but need only maintain their current
level of assistance
expenditures.[20] In
National League of Cities itself, the Supreme Court distinguished
the costly wage and hour requirements of the Fair Labor Standards Act from
the provisions of the Economic Stabilization Act of 1970, Pub. L. No.
91-379, 84 Stat. 799 (1970), 12 U.S.C. § 1904 note (1976), approved in
Fry v. United States, 421 U.S. 542 (1975). That statute had
authorized the President to freeze temporarily the wages paid state and
local government employees in order to combat inflation. Such
congressional action, the Court indicated in National League of
Cities, was not contrary to the Tenth Amendment because, among other
things, the freeze

displaced no state choices as to how governmental operations should be
structured, nor did it force the States to remake such choices themselves.
Instead, it merely required that the wage scales and employment
relationships which the States themselves had chosen be maintained during
the period of the emergency.

426 U.S. at 853. That reasoning is equally applicable to the provision at
issue in this case.

Appellants insist that section 1618 is nevertheless coercive because the
effect of violating the condition -- loss of Medicaid funds -- is so
drastic that the states have no choice but to comply. We are unpersuaded.
The Supreme Court admonished in Steward Machine Co., that courts
should attempt to avoid becoming entangled in ascertaining the point at
which federal inducement to comply with a condition becomes compulsion.
Justice Cardozo wrote in that case, "to hold that motive or temptation is
equivalent to coercion is to plunge the law in endless difficulties." 301
U.S. at 589-90.

The wisdom of those words is illustrated by the determination that
appellants would have us make. The courts are not suited to evaluating
whether the states are faced here with an offer they cannot refuse or
merely a hard choice. Even a rough assessment of the degree of temptation
would require extensive and complex factual inquiries on a state-by-state
basis.[21] We therefore follow
the lead of other courts that have explicitly declined to enter this
thicket when similar funding conditions have been at issue. For example,
in New Hampshire Dep't of Employment Security, which was approved
by this court in County of Los Angeles v. Marshall, see 631 F.2d at
769, the First Circuit held:

We do not agree that the carrot has become a club because rewards for
conforming have increased. It is not the size of the stake that controls,
but the rules of the game.

In sum, we find the pass-through condition consistent with the Tenth
Amendment. Appellants' reliance on National League of Cities is
misplaced because the provision at issue here is neither grounded on
Congress' power under the commerce clause nor is it coercive. The impact
of the pass-through provision on state activities does not render the
condition invalid, and does not act to alter its essential nature as a
permissible use of the congressional spending power to encourage state
cooperation with federal plans.

IV. THE SCOPE OF THE PASS-TROUGH PROVISION

Appellants' final argument raises an issue of statutory construction:
they contest the Secretary's interpretation of section 1618 as applying
not only to state supplementary payments that increase the benefits
supplied SSI recipients, but also to state supplementation in the sense of
assistance to those who, because of their income level, are ineligible for
SSI benefits. This second category of supplementation will be referred to
here as "state-only" benefits. The district court found that this
challenge was not ripe because at that time the Secretary had not yet
promulgated final regulations implementing the pass-through provision. See
480 F. Supp. at 588. Since the decision below, however, those regulations
have been adopted. See 45 Fed. Reg. 54,742, 54,743, 54,749 (1980) (to be
codified at 20 C.F.R. § 416.2095(b)(3)). The question is therefore ripe
for review, and we turn now to discuss the merits of appellants'
claim.[22]

The language of the pass-through provision is unambiguous in including
both types of state supplementation. The state aid to which section 1618
applies consists of those "supplementary payments of the type described in
section 1382e(a) of this title." Act § 1618(a), 42 U.S.C. § 1382g(a)
(1976). The incorporated section, which is the portion of the Act that
provides for state supplementation, defines state supplementary benefits
as

[a]ny cash payments which are made by a State (or political subdivision
thereof) on a regular basis to individuals who are receiving benefits
under this Subchapter or who would but for their income be eligible to
receive benefits under this subchapter, as assistance based on need in
supplementation of such benefits.

Appellants argue that, despite this language, section 1618 could not
possibly have been meant to refer to the state-only cases because aid to
those who are not SSI beneficiaries does not "supplement" any federal
payment. But a state may supplement a federal assistance program in two
ways -- either by supplying aid to those who are ineligible for federal
benefits[24] or by increasing
the amount of the benefit given federal recipients. State-only benefits
are also supplementary in the sense that they supplement recipients'
income. Use of the term "supplementary" in the pass-through provision to
refer to both types of state assistance is therefore not unreasonable.

Appellants next point to the absence of any indication in the legislative
history that Congress intended the pass-through provision to apply to
state-only cases. Section 1618 was offered as a floor amendment, and the
only relevant legislative history therefore appears in the debates. It is
true that this discussion focused on Congress' primary concern -- that SSI
recipients receive the benefit of cost-of-living increases. But courts
need not find affirmative legislative history to support application of a
statute according to its plain meaning. See, e.g., Caminetti v. United
States, 242 U.S. 470, 485-86, 490 (1917).

As the contemporaneous construction of the agency charged with the
statute's enforcement, the Secretary's regulations are entitled to
deference from this court. See, e.g., Udall v. Tallman, 380 U.S. 1,
16 (1965); Power Reactor Development Co. v. International Union of
Electrical, Radio & Machine Workers, 367 U.S. 396, 408 (1961). The
Secretary's interpretation of the scope of the pass-through condition was
based on the specific reference to state-only cases in section 1616(a) of
the Act, the section quoted above that is incorporated in the pass-through
provision,[25] and the
relatively equal financial position of those who are eligible for both SSI
benefits and a state supplement, on the one hand, and, on the other, those
who receive only a state supplement. See 45 Fed. Reg. at 54,743.

As noted above, we approve the Secretary's reading of the language of
section 1618. The second premise of the interpretation -- that inclusion
of the state-only cases is conducive to fair and effective implementation
of the legislative intent -- is precisely the type of determination best
left to an agency with expertise in the field. Moreover, as appellees
point out, the conclusion is reasonable that enforcement of the
pass-through condition would be impossible if states were permitted to
reduce the level of benefits given to those who receive only state
supplements. A number of states dispense all supplementary benefits in a
single program, without regard to whether or not the beneficiary also
receives federal SSI benefits. If appellants' construction of section 1618
were correct, so that some recipients of state supplements -- those also
eligible for SSI -- might suddenly begin receiving greater benefits than
did others -- those only eligible for state supplements -- the Secretary
would clearly be hampered in his ability to determine whether the state
was complying with the difficulty of enforcing section 1618, when one
considers that the pool of persons eligible for SSI is constantly
fluctuating. Cf. North Carolina ex rel. Morrow v. Valifano, 445 F.
Supp. 532, 536 (E.D.N.C. 1977) (three-judge court) (requiring certificates
of need for all new health facilities -- whether publicly or privately
financed -- held legitimate to prevent thwarting of congressional
purpose), aff'd mem., 435 U.S. 962 (1978).

We therefore uphold the regulations' interpretation of section 1618:
including state-only cases within its scope accords with the statutory
language and is a reasonable exercise of the Secretary's authority to
ensure fair and manageable administration of the
provision.[26]

V. CONCLUSION

We find the pass-through provision of the Social Security Act, § 1618, 42
U.S.c. § 1382g (1976), a conventional and appropriate exercise of
Congress' authority under the spending clause. The courts have long
recognized the legitimacy of Congress' interest in ensuring the proper use
of federal funds and have upheld a variety of terms attached to federal
grant programs for that purpose. These conditions need not be restricted
to those areas over which Congress has direct regulatory authority, and
they need not be, as appellants urge, exactly correlated with the purpose
of the funding program conditioned.

The pass-through provision was enacted for the permissible objective of
guaranteeing that SSI cost-of-living increases approved by Congress
benefit those whom they were designed to assist, rather than subsidize the
states. The inclusion of the pass-through section in Title XIX, relating
to Medicaid, rather than in Title XVI, dealing with SSI, does not render
the condition unconstitutional. This court does not generally instruct
Congress on drafting and structuring statutes, and, in any event, even
appellants' rigid nexus standard is satisfied. The purpose of section 1618
-- to ensure a certain level of benefits to SSI recipients -- is closely
tied to the aims of the Medicaid program, which is a related component of
Congress' attack on poverty. The legislative history of the Act and of its
amendments, the evolution of the statute's current structure, and other
exercises of Congress' power to condition receipt of federal funds all
corroborate this link between the two programs.

We likewise find the pass-through provision unobjectionable under the
Tenth Amendment. The Supreme Court's opinion in National League of
Cities v. Usery, 426 U.S. 833 (1976), is not controlling because it
involved a statute that was based on Congress' power under the commerce
clause and that compelled action by the states. Section 1618, in contrast,
is premised on the spending power and is not coercive.

Finally, we reject appellants' challenge to the regulations interpreting
the scope of the pass-through provision. The Secretary's determination
that section 1618 applies to state supplementary payments in state-only
cases is entitled to a good deal of deference from this court. In the
absence of any controlling legislative history, the Secretary reasonably
relied on the statutory language and his expert judgment of the
prerequisites for fair and effective implementation of the pass-through
provision.

[1] Appellants are the states of
Alabama, Connecticut, Florida, Idaho, Illinois, Louisiana, Missouri,
Nebraska, Oklahoma, Virginia, and Washington. Colorado and Michigan were
parties below but have not joined in this appeal.

[2] That Department has been
redesignated the Department of Health & Human Services, see 20 U.S.C.
§ 3508 (Supp. III 1979), but will be referred to here by its former title,
which was in effect when appellants filed their complaint.

[4] The federal government
agreed to reimburse a state for any difference between the amount of state
funds paid in 1972 under the original matching fund program and the amount
required in supplementary payments to maintain benefits at the 1972 level.
See Pub. L. No. 92-603, § 401, 86 Stat. 1485 (1972), 42 U.S.C. § 1382e
note (1976). As a result of increases in the federal SSI benefit level,
this "hold-harmless" clause now affects only three states -- Hawaii,
Massachusetts, and Wisconsin -- none of which is a party to this case.

[5] The only exception is due to
the hold-harmless clause of the Act. See note 60 supra.

[6] For example, only thirteen
states passed through the entire 1976 SSI cost-of-living increase, while
eight states passed through part of that increase. See 122 Cong. Rec.
24,455-56 (1976) (remarks of Rep. Fraser); see also id. at 34,543
(remarks of Sen. humphrey) (similar figures for 1975).

(a) In order for any State which makes supplementary payments of the type
described in section 1382(a) of this title (including payments pursuant to
an agreement entered into under section 212(a) of Public Law 93-66), on or
after June 30, 1977, to be eligible for payments pursuant to subchapter
XIX of this chapter with respect to expenditures for any calendar quarter
which begins --

(1) after June 30, 1977, or, if later,

(2) after the calendar quarter in which it first makes such supplementary
payments,

such States must have in effect an agreement with the Secretary whereby
the State will --

(3) continue to make such supplementary payments, and

(4) maintain such supplementary payments at levels which are not lower
than the levels of such payments in effect in December 9176, or, if no
such payments were made in that month, the levels for the first subsequent
month in which such payments were made.

(b) The Secretary shall not find that a State has failed to meet the
requirements imposed by paragraph (4) of subsection (a) of this section
with respect to the levels of its supplementary payments for a particular
month or months if the State's expenditures for such payments in the
twelve-month period (within which such month or months fall) beginning of
the effective date of any increase in the level of supplemental security
income benefits pursuant to section 1382 of this title are not less than
its expenditures for such payments in the preceding twelve-month
period.

42 U.S.C. § 1382g (1976).

[8] See notes 76 & 78
infra. In the three hold-harmless states, see notes 60 &
61 supra & accompanying text. Congress prohibited the federal
government form failing to pass through an SSI cost-of-living increase by
reducing its payments to support the state level of supplementation. See
Pub. L. No. 94-585, § 2(b), 90 Stat. 2902 (1976), 42 U.S.C. § 1382e note
(1976).

[10] Appellants insist that
dictum in two Supreme court cases supports the nexus requirement they
propose. See Massachusetts v. United States, 435 U.S. 444, 461
(1978) (plurality) ("We have repeatedly held that the Federal Government
may impose appropriate conditions on the use of federal property or
privileges and may require that state instrumentalities comply with
conditions that are reasonably related to the federal interest in
particular national projects or programs."); Ivanhoe Irrigation Dist.
v. McCracken, 357 U.S. 275, 295 (1958) ("Also beyond challenge is the
power of the Federal Government to impose reasonable conditions on the use
of federal funds, federal property, and federal privileges. . . . [T]he
Federal Government may establish and impose reasonable conditions relevant
to federal interest in the project and to the over-all objectives
thereof.").

Neither of these cases involved an argument that a term set by Congress
was unrelated to the federal funds conditioned. In fact, in
Massachusetts a user charge imposed on the states was challenged on
the ground that states are immune from federal taxes; the plurality
mentioned the spending power only by way of analogy. Moreover, in neither
case did the Court adopt the rigid test advanced by appellants. The
language quoted above may indicate only that the spending power must be
exercised for the general welfare -- that is, that a condition exceeds
Congress' power if it is "unrelated in subject matter to activities fairly
within the scope of national policy and power." Steward Machine Co. v.
Davis, 301 U.S. 548, 590 (1937);see also United States v. Butler, 297
U.S. 1, 66-67 (1936); Texas Landowners Rights Ass'n v. Harris, 453 F.
Supp. 1025, 1030 (D.D.C. 1978), aff'd mem., 598 F.2d 311 (D.C. Cir.),
cert. denied, 444 U.S. 927 (1979); North Carolina ex rel. Morrow
v. Califano, 445 F. Supp. 532, 535 (E.D.N.C. 1977) (three-judge
court), aff'd mem., 435 U.S. 962 (1978); Vermont v.
Brinegar, 379 F. Supp. 606, 616 (D. Vt. 1974).

[11] We note, however, that
Congress has acknowledged the importance of state supplementation to the
federal government's efforts to alleviate economic insecurity -- the goal
of both the Medicaid program and SSI, see text accompanying notes
68-70 infra. Congress encouraged the states to furnish optional
supplementary aid to the needy when it established the SSI program.
See H.R. Rep. No. 231, 92d Cong., 1st Sess. 199 (1971). The
legislative history of the pass-through provision similarly reflects
congressional recognition of the necessity of state supplementation.
See, e.g., 122 Cong. Rec. 28,284, 28,283, 28,280, 24,455 (1976)
(remarks of, respectively, Reps. Daniels, Abzug, O'Neill, Fraser).

Appellants complain, however, that the states were led to believe that
supplementation of SSI benefits was completely discretionary and could be
reconsidered at any time. See H.R. Rep. No. 231, 92d Cong., 1st
Sess. 199 (1971). But states cooperating with the federal government under
the SSI program were clearly to be subject to such conditions "as the
Secretary [found] necessary for effective and efficient administration."
Id. at 200. Moreover, as the Supreme Court pointed out in
Helvering v. Davis, 301 U.S. 619, 641 (1937), Congress' decisions
regarding use of the spending power may change over time for "the concept
of the general welfare [is not] static." In enacting the pass-through
provision, Congress clearly spoke unambiguously enough to enable the
states to make an informed choice whether to accept the terms imposed.
Cf. Pennhurst State School & Hospital v. Halderman, 101 S.Ct.
1531, 1539-45 (1981).

[12] The Act provides that
states may treat SSI recipients as automatically eligible for Medicaid.
See Act § 1902(a)(10), 42 U.S.C. § 1396a(a)(10) (1976).
Alternatively, a state may determine Medicaid eligibility by other
criteria, which may be not more restrictive than those applicable to the
state's cash assistance program on January 1, 1972. See id. §
1902(f), 42 U.S.C. § 1396a(f). Fifteen states have chosen the latter
option. See Brief for Amicus Curiae at 6-7.

Mr. HUMPHREY . . . . My amendment, as the Senator knows, would not
require any State to increase its supplementary aid to any SSI recipient.
It would only require that the States not reduce their level of
support.

We did that in revenue sharing. In revenue sharing we required that State
governments are required to maintain their intergovernmental transfers to
all units of local government at fiscal 1972 levels.

Mr. LONG. In one way or another, time and again we have done things such
as the Senator is suggesting.

[14] Appellants argue,
however, that the legislative history of section 1618 evidences no
consideration by Congress of the relationship between that provision and
the Medicaid program. We do not find the lack of discussion surprising or
significant. The earlier legislative history of the Act and the conditions
similar to the pass-through provision previously imposed by Congress
suggest that the relationship between Medicaid and SSI is so well-accepted
as to be implicit. Moreover, this court's duty is to interpret
legislation; we do not generally instruct Congress on the type of findings
it should make, or the type of discussions it should have, before passing
a bill.

[15] We assume, for example,
that appellants would have no objection were the Act still structured
according to type of beneficiary, and had Congress conditioned receipt of
health care funds to assist the aged on a state's agreement to share
responsibility for the cost of providing subsistence benefits to that
group. The condition and the restricted funds would then involve the same
program, the same title of the statute, and the same beneficiaries. We
find no substantive distinction between this hypothetical and the case at
bar.

[16] At oral argument, counsel
for appellants admitted that the states argument would be weaker if
Congress had included in section 1618 a finding about the relationship
between Medicaid and the pass-through condition.

[17] "The powers not delegated
to the United States by the Constitution, nor prohibited by it to the
States, are reserved to the States respectively, or to the people." Amend.
X.

[20] Not only are the states
subject to no requirement that they increase expenditures on assistance
programs, but they save roughly $124 million as a result of the enactment
of SSI and federalization of aid programs: appellants spent approximately
$317 million on aid to the aged, blind, and disabled in 1973 but only some
$193 million in supplementary payments in 1976. See Defendants' Statement
of Material facts as to Which There Is No Genuine Issue at 2, reprinted
in Joint Appendix (J.A.) at 30, 31; cf. Plaintiff's Statement
in Response to Defendants' Statement of Material Facts as to Which There
Is No Genuine Issue at 1, reprinted in J.A. at 32, 32 (calculating
appellants' 1976 supplementary payments as totalling $199 million). But
see generally Reichenthal v. Harris, 492 F. Supp. 637, 640 (E.D.N.Y.
1980).

Appellants assert that the pass-through provision will entail increased
costs for the states because caseload fluctuations and forecasting
difficulties will prevent a state from being able to maintain exactly its
total expenditures from the prior year. In order to avoid the risk of
being found in noncompliance, appellants continue, the state will likely
increase expenditures. The Secretary foresaw this problem, however, and
the regulations permit a state to correct a shortfall for any twelve-month
period by making it up during the subsequent year or by making a single
retroactive payment to affected beneficiaries. See 45 Fed. Reg.
54,742, 54,744, 54,749-50 (1980) (to be codified at 20 C.F.R. § 416.2096).
See also note 78 infra.

[21] Arizona, for example,
does not participate in the Medicaid program and therefore is presumably
uninfluenced by the pass-through provision. See Brief for Appellees
at 22.

[22] The Secretary's
regulations define the supplementary payment level that may not be reduced
under § 1618 as the total state payment given an individual with no
countable income in December, 1976. See 45 Fed. Reg. 54,742, 54,744,
54,750 (1980) (to be codified at 20 C.F.R. § 416.2097(a)). Those persons
in the state-only category whose outside income does not increase may be
entitled to an increase in the state supplementary payment as a result of
the pass-through provision and its implementing regulations.

Suppose, for example, that A, an SSI beneficiary with no outside income,
receives $150 from the federal government and $50 from the state, for a
total income of $200. Assume also that B has an income of $165 and is
therefore eligible only for state benefits; he would receive $35 from the
state, for a total income, again, of $200. An SSI cost-of-living increase
of $10 must be passed through to the recipients, so that A's income is now
$210. If B's outside income does not change, the regulation's definition
of supplementary payment level requires that the state increase its
supplementary benefits to B by $10 so that he too has a total income of
$210.

The Secretary considered this interpretation of "level" the one
consistent with the legislative purpose of § 1618. The only other real
alternative was to define "level" as the amount of state supplementation a
particular individual receives. The Secretary rejected that construction
for two reasons. It would mean, in the hypothetical above, that the state
could not reduce its payment to A below $50 or its payment to B below $35.
State benefits would then be frozen and could not reflect increases in a
recipient's outside income. Moreover, individuals who became eligible for
SSI after December, 1976, would not be protected by the pass-through
provision. See 45 Fed. Reg. at 54,744-45.

Although § 1618 may require that a state increase payments to particular
individuals, it does not as a result put an additional burden on the
states. The Secretary has pointed out that the group of aid recipients
represented by B in our hypothetical is not a large one. Typically, those
in the state-only category are eligible for social security benefits under
Title II of the Act. Those payments increase automatically in response to
the cost of living. See id. at 54,745. If B's outside income of
$165 rises because of an increase in social security benefits, the state's
need to increase its aid to him would be correspondingly reduced.
Moreover, the states' fiscal concerns are met by the pass-through
sections' provision that states are in compliance with its mandate if
their total expenditures on supplementary benefits in any year are not
less than the total spent during the preceding twelve months. See
Act § 1618(b), 42 U.S.C. § 1382g(b) (1976); see also note 76
supra.

[23] The pass-through
provision refers also to supplementation under Pub. L. No. 93-66, § 212,
87 Stat. 155 (1973), 42 U.S.C. § 1382 note (1976), which conditioned
states' eligibility for Medicaid funds on their willingness to supplement
SSI benefits to ensure that no recipient lost income as a result of the
enactment of the SSI program. See note 60 supra &
accompanying text. Like § 1616(a), quoted in text, § 212 applies to both
types of supplementation. No other section of the Act differentiates
between the two categories of state benefits.

[24] A provision in Title XIX
illustrates this type of supplementation. Section 1902(a)(10)(C), 42
U.S.C. § 1396a(a)(10)(C) (1976), permits states to furnish supplemental
Medicaid coverage to needy persons who would not otherwise receive
Medicaid benefits because their income makes them ineligible for SSI or
because they do not meet the state's eligibility criteria, see note
68 supra.

[25] The regulations are also
premised on the inclusion of both types of state supplementation in the
other provision referenced in the pass-through section, Pub. L. No. 93-66,
§ 212, 87 Stat. 155 (1973), 42 U.S.C. § 1382 note (1976). See 45
Fed. Reg. 54,742, 54,743 (1980); see also note 79 supra.

[26] Appellants urge that this
court reject the Secretary's construction of section 1618 in order to
avoid a difficult constitutional question; they maintain that the
pass-through provision is even more suspect if it applies to state-only
cases because of the greater attenuation between that type of state
supplementation and the Medicaid program. We dismiss this argument for the
reasons discussed above in part II(B); see especially note 66
supra. Moreover, we note that in some states recipients of
state-only benefits are automatically eligible for Medicaid. See,
e.g., Brief for Amicus Curiae at 8 (Alabama); id. at 17
(Oklahoma).

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